Aetna - May Cover

[asherje 81]

Good news is Aetna covers revisions but they have criteria to meet, which according to my doctor I have met.

•2yr weight history

• medical problems from band

• blood pannel

• 90 day weight management

Catch, the doctor (not my original surgeon who did band) will only do revision after I meet with their nutritionist for 3 months (I've been going to different ones for 2yrs) with a $50 fee each time since she doesn't take insurance, see their psychologist (again doesn't take insurance $300) then go before their board for review then based on all this would be scheduled for surgery. I know their not asking anything insane, but with being so sick for so long it's made work hard and my finances depleted. So the thought of $450 just to get to the surgery and then my cost to cover my portion is frustrating, not to mention the thought of having to wait at minimum another 3-4months to get this nightmare out of me, I'm so sick an tired of being sick and in pain.

Anyone have Aetna and also a doctor with something like this? How did it work out for you?

[Lauranbob Mc 94]

had aetna also and the NUT was included in everything. I still had a 3000 co-pay but it was worth it

[max3sons 4]

I have AETNA also and just had my redo from a Lapband to the Sleeve. They paid for it all. I was at 190 the first time (I am 5 foot nothing) this second time I was 167, just knew they would not do it again BUT THEY DID. Am home sipping chicken broth and so excited. So do not get discouraged.

[luckylady131 51]

Be glad your insurance pays. I had Aetna when I was working, and my plan covered bariatric surgery. Then I quit to be a stay at home mom 2 years ago, and my husband also has Aetna. But his company refuses to pay for bariatric surgeries. So same insurance, different coverages. So I ended up being self pay. So $500 and a few months is way better than being out the $12,000 I paid. Could have gone to Mexico I suppose, but wanted to do it stateside.

If there's one thing this surgery will teach you (before and after!)...it's PATIENCE!!

Good Luck!

[asherje 81]

Oh don't get me wrong I am happy they are willing to cover most the surgery. When I had the band done 4 1/2yrs ago my insurance wouldn't cover it and I had to take a 13,000 loan out. Still paying it back. Just frustrated that the doctor is requiring me to spend the $450 with his people before he will allow me to have the surgery, then at that point will have to pay 10% of the surgery. Also I was hoping to be able to have it removed sooner, I'm just so sick of throwing up, the GI issues and pain.

[frustratedbandster 0]

I have AETNA also and just had my redo from a Lapband to the Sleeve. They paid for it all. I was at 190 the first time (I am 5 foot nothing) this second time I was 167, just knew they would not do it again BUT THEY DID. Am home sipping chicken broth and so excited. So do not get discouraged.

Hello everyone - I am a newbie to this site and am looking for some help with Aetna

Question for those of you with Aetna seeking revision from LB to VSG - how did you get Aetna to pay? My band has a severe prolapse (documented with GI, showing that barium just sits on my espohagus causing reflux and spasms. Originally had lost 130 lbs and have regained 30.

When I got banded in 4/2010 Aetna approved the proceedure in 48 hours. And I was very happy with the band and my weight loss. Flash forward to 5/2012 when I began being unable to eat solid Protein, but could eat things like saltines with out any problem!

Made an appt for a my first ever fill 3cc and have been so unhappy since. The doc removed the fill completely in 6/2012 and then sent me for an GI in 7/2012 and called me last week and doctor is suggesting revision to sleeve. Think it would be best for me as I have battled nausea and reflux, for quite sometime now.

Thinking that he must feel that my case is valid and Aetna will approve, but I am worried. So - those of you with Aetna who were able to revise, please tell me your experience and what your approval process looked like.

Did Aetna treat the revision from LB to VSG as a new surgery? Meaning did you have to requalify for the surgery or were you able to just get the revision to VSG approved with proof of the problem?

Hoping that they will approve soon as I have pain and the doctor is concerned about my needing the procedure done as an emergency.

Also, were you able to have the LB removed and the VSG done at the same time? How long were you in the hospital for?

Appreciate any feedback or advice from those of you who have been there and done that!

Hoping for the best and preparing for the worst when it comes to dealing with Aetna!!

Tori